C HINESE M EDICINE :

N ATURE VERSUS C HEMISTRY AND TECHNOLOGY

Paul U. Unschuld

Medical ideas that underlie the practice of Chinese medicine, have

been received with increasing attention and acceptance in Europe
and the United States in the last decades. The so-called scholas-
tic medicine gets no good press at the moment; spectacular positive
reports seldom make the headlines of the popular press. Instead, neg-
ative reports about the behavior of individual doctors, about the mo-
tives of drug companies, or about the alleged threat to traditional val-
ues and behavior by new possibilities of medical intervention abound.
In their totality and their continual succession, these negative re-
ports tend to produce unrest in the population, if they do not unleash
deep existential anxieties. To blame these reports for the growth in
fear and anxiety with regard to modern medicine would of course be
short-sighted.
On the contrary, we should ask the question whether such negative
headlines are merely a visible sign of changing times, or whether they
signal a deviation from unconditional faith in science and technology
as good and beneficial.
The new zeitgeist manifests itself in numerous areas of our public
and private life; it finds expression in electoral behavior as in individ-
ual reaction to actual or future illness, I have not chosen the exam-
ples of electoral behavior and of health and sickness by chance. The
fact that some 10% of the population places its trust in the so-called
“Green” Party is a clear indication for the high degree of emotional
attraction which the problem of the environment and protection of
nature exerts. Highly dubious elements of the Greens’ policy, such
as its unconcealed sexism are swallowed by voters as evidently di-
gestible irrelevances in relation to the central promise of the Greens
to deal with one of the most important causes of existential fear in
the population-the environmental problem.
Since none of the traditional parties has taken the environmental
issue seriously, they should not be surprised that voters for whom a
health environment is a top priority are walking away.
Ladies and Gentlemen, I have made this little digression in order
to impress upon you the fact that a segment of the population no
long chooses the medicine taught in this faculty and practiced here
in the Grofihadern Clinic and that this fact is not to be seen as an
isolated phenomenon but as a part of a general change in the outlook
of Western civilization. The dictum of one of our colleagues that,
quote, “when they really fall sick, they come back to GroBhadern in
the end” is true in the majority of cases. Yet, the suggestion that
the people turning to Chinese medicine are hypochondriacs helps our
understanding of the “rise of Chinese medicine” as little as the efforts

Speech given in Faculty of Medicine of the University of Munich??? under the

title of Die Chinesische Medizin: Natur uersus Chemie und Technologie. Trans-
lated by Nigel Wiesman
 P AUL U. UN S C H U L D 3

of critical commentators of the past to ascribe the belief in yin and

yang solely to alternative cranks.
My own involvement with Chinese medicine began in the sixties
when only a discrete minority of physicians had ever even heard of
acupuncture or applied the technique clinically. On own interest in
Chinese medicine has consistently concentrated on the aspects of Chi-
nese that relate to history of science, its nature, and its language;
the health-policy implications of the reception and spread of Chinese
medicine in the West came later.
I think I have a certain overview of two thousand years of tradi-
tional Chinese medicine, and I think over 25 stays of varying length in
East Asia give me an overview of the present situation of traditional
Chinese medicine in China, Taiwan, and Japan.
Prom this angle, I can state that there is no such thing as the
Chinese medicine. We can distinguish between different periods in its
historical development, which stretches from the beginning of medical
thought and activity in Chinese just about 2000 years ago to the end
of the imperial age at the beginning of this century, through a period
of redefining of traditional Chinese medicine under the PRC policy
of the past 50 years, finally to a period of reception of traditional
Chinese medicine in the West.
In all three of these periods, Chinese medicine has meant some-
thing different. To understand this is important not least for our
reaction to the increasing interest in TCM.
Let me therefore describe the three periods briefly. A healing art
that involved appeal to ancestors, exorcism of demons, or the prag-
matic or magical application of animal, plant, or human substance
was already present in the in the prehistorical era.
By contrast, a medicine in the Hippocratic sense, that is, one based
on efforts understand and treat disease in terms of natural laws, is an
achievement that first appeared in the third or second century before
Christ, i.e., only slightly later than in ancient Greece.
Insight into the natural laws and the application of this insight into
a new picture of the organism coincided with the unification of China
the foundation of the Chinese empire. Without going into this here,
it is nevertheless to be noted that the structure of the body and its
organs as it was understood at the time evinces both clear conceptual
and terminological parallels with the Chinese imperial state.
The continuing existence of the imperial establishment over a pe-
riod of two thousand years up to the beginning of the 20th century
maintained the external foundations of the view of the individual
body, the causes and best possible methods of treatment of disease.
Chinese medicine has by no means stagnated over these two thou-
sand years, a point I will come back to in due course. Yet in its
basic conception with regard to the individual organism, it remained
essentially as unchanged as the organism of the state whose political
health rested on the same principles.
If we cast a glance at Europe, then we easily see one of the causes
for the continual change and often a simultaneous variety of medical
constructs. Hardly once since antiquity did a political constitution
last for several centuries; with change in the political constitution,
there ensued a fundamental change in the conception of our bodily
constitution. The continual change in basic political structures Eu-
4 N ATURE V ERSUS C HEMISTRY AND TECHNOLOGY

ropean history over the last two thousand years has manifested in
manifold changes in medical thought.
Neither in Europe nor in China has man been able to interpret dis-
ease of his personal organism in a way different from than in which
he interprets crises in the social organism. Neither in China nor in
Europe has medicine ever stood outside the prevailing world view.
Chinese medicine-and here we should place an important argument
of its proponents in perspective-did not survive for two thousand
years because its basic convictions were clinically so effective or cor-
rect, but rather because these basic convictions coincided with the
convictions that underlay the society of the imperial age. Only when
the world view of the imperial age came to a definitive end in 1911 did
the fundamental plausibility of traditional Chinese medicine crumble
and a new medicine that responded to the new age gain widespread
acceptance.
This development did not become fully sustained until a few years
after the founding of the PRC in 1949. Before assuming power, the
Chinese Marxists had for decades had opposed Chinese medicine with
the same vigor as they had opposed all the ideas of the imperial age
with which it was inextricably tied. A well-known Marxist ideologist
of the 1940s even went so far as to Chinese medicine was nothing
more than a millennial dung heap. But after the founding of the
PRC, communists were faced with the problem of having to recognize
and utilize practitioners of Chinese medicine at least temporarily in
order to meet health care needs in the absence of a sufficient number
of doctors trained in the modern scientific medicine they preferred.
From this time, Mao Zedong viewed traditional Chinese medicine as a
“treasure chest” although it lay hidden in the jumble of unacceptable
speculative trimmings, from which the pure wealth of experience of
the people had first to be separated.
Since the founding of the PRC, the Communists have never at
any time accepted TCM unconditionally. The aim of the PRC gov-
ernment has consistently been primarily to offer the people modern
Western medicine, and this aim has in the meanwhile been impres-
sively achieved and is being further through the effects of the recent
economic reforms on health care.
Nevertheless, the communist leadership has paid a great deal of
attention to traditional Chinese medicine, and over the years has used
various political instruments to reduce the vast manifold spectrum of
ideas and techniques that developed in the imperial age to a small,
clearly defined segment that in modern China alone is recognized as
Chinese medicine.
A feature of the development of Chinese medicine in the two thou-
sand years of the imperial age was the increasing number of differing
doctrines concerning etiology, physiology, and therapy that existed
simultaneously. On the basis of a few common fundamental ideas,
Chinese doctors over the centuries developed numerous approaches
for dealing with sickness. Unlike the situation in Europe, there was
no tendency to develop a school of opinion that was based on at
least a majority, if not, ideally, on the unanimous agreement of all
those involved that persisted until it was replaced by a new school of
thought.
In the history of Chinese, progress from one commonly sustained
paradigm to the next is not apparent; broadening of knowledge would
6 NATUREVERSUS CHEMISTRY AND TECHNOLOGY

interpretation of Chinese medicine fed with ceylonese folk medicine

emanating from well-known Guru in Sri Lanka.
Ladies and Gentlemen, in the past, petitions have repeatedly with
a certain political emphasis been placed before this faculty to open
itself to Chinese medicine and provide instruction in it. Those who
exert such pressure are unaware of the difficulties that such a move
would involve. As I have said before, there is no such thing as the
Chinese medicine, and so it would have to be agreed first what variant
of the versions of Chinese medicine concocted by many individuals
and interest groups would be considered as the subject of study in a
medical faculty.
The question to be answered is extremely complicated. Since
Chinese medicine sought as an alleged alternative to Western school
medicine, the scientific argument is actually excluded. If we wanted to
adopt only those elements of Chinese medicine that could be proven
scientifically, not much would be left. Yet we do not have any other
criterion.
We should therefore ask ourselves what the features of Chinese
medicine are, and why this medicine appears so attractive to so many
people.
I would like now to go back to the beginnings of Chinese medicine.
Information about the earliest stage of the development of Chinese
medicine is provided by the texts from the Mawangdui tomb, which
was sealed in 167 B.C. Several aspects of the texts are particularly
interesting.
These texts present us with an already highly developed, very
pragmatic, one could almost say empirically legitimized healing art.
Hundreds of substances, complex preparations of crude drugs, and a
broach range of internal and external of application methods tell of
high level of this pharmaceutically oriented healing art. Other meth-
ods are evidenced by the texts, e.g., massage, moxa cauterization,
petty surgery, gymnastics, dietetics, therapeutic sexual practices, and
exorcism techniques for the elimination of demons. Acupuncture was
mentioned in neither these nor other contemporary texts. It appears
for the first time in a text from the year 90 B.C., and it would ap-
pear therefore that this currently most well-known Chinese method
of healing in Chinese cannot look back to as hoary a past as popular
writings on the subject would suggest.
Drug therapy and acupuncture were from the very beginning two
separate healing traditions in China. The pharmaceutical tradition
of Chinese medicine over the centuries developed into the dominant
method of treating illness. The traditional Chinese pharmaceutical
literature grew very rapidly into an impressive corpus.
This body of literature includes on the one hand innumerable for-
mularies in which prescriptions for a well-structured and easily under-
stood categorization of diseases introduced, and on the other almost
two thousand pharmaceutical books which deal primarily with indi-
vidual substances and their effects. Nothing in this pharmaceutical
traditional appears to esoteric or wrapped in Oriental mystique to the
modern Western reader. The thinking that lies behind this Chinese
drug healing is different in no way from the traditional application of
drugs in Europe.
Either the Chinese authors refrained completely from naming mech-
 P AUL U. U N S C H U L D 7

anisms or provided only indications and suitable prescriptions, or the

drugs served to expel an evil that had penetrated the body by caus-
ing vomiting, sweating, or downward elimination from the body, or
by destroying it within the body.
This approach is well-known to us, and it is not surprising that
this main tradition of Chinese medicine over the last two thousand
years is not at the forefront in the reception of a Chinese alternative
to Western medicine. Interestingly, what the Chinese understand
by the term “Chinese medicine” is the drug tradition that for two
thousand years has been the dominant element, while acupuncture is
considered to be a separate form of therapy.
It is exactly the other way round in the West. Here, the buzz
word ‘Chinese medicine” denotes almost exclusively acupuncture, a
method of treatment with only a second- or third-ranking significance
in China that was characterized as forgotten tradition by writers of
the eighteenth century and by a decree of 1822 was considered unsuit-
able for use among the upper classes. Acupuncture only experiences
a belated respect today because of the regard it is given in the West.
Of course, the acupuncture that is nowadays understood and ap-
plied in the West as Chinese medicine is far removed from the needle
therapy of two thousand years ago. Acupuncture-as is now very
clearly to be seen-developed from bloodletting. The oldest extant
texts on needling show clearly how efforts to treat disease by bleed-
ing were replaced with the attempt to influence flowing streams of
pneuma deep within the body.
In contrast to the pharmaceutical tradition, which has always been
explicitly dedicated to the treatment of manifest disease, the early
texts of acupuncture therapy forcefully recommend early treatment
of the preliminary stages of disease development as a therapeutic
approach. The aim of needling should be the early treatment of
minor disturbances in preliminary development of serious diseases.
This approach is true to the Confucian maxim that the nobleman
does not seek to impose order in political unrest, but seeks order
before unrest has erupted.
Theorizing about physiology, etiology, and therapy proceeded from
this goal. In acupuncture therapy there arose theoretical constructs
which in the modern West exert an equally powerful fascination and
which account for the attraction of Chinese medicine as an alterna-
tive, holistic medicine.
Acupuncture sees the body as being composed of twelve functional
entities, which interrelated in busy functional exchange. Diseases
only arise where one or more of the functions of the body is weakened.
Such weakenings arise when abnormal emotions stretch the resources
of a functional entity beyond their limits.
Excessive brooding damages the liver, excessive sorrow damages
the spleen. When I speak of liver and spleen here, than I mean the
not merely, not even primarily, the organs that are familiar to us but
the functions of the organism which were associated with the organs
in the sense of broad functional units. In the case of the liver, damage
can also affect the function of the eyes.
To stay with the example with the excessive emotional strain, if
a weakening arises, then the body becomes susceptible to harmful
forces present in the environment. Cold, heat, dampness, and dry-
8 N ATURE V ERSUS C HEMISTRY AND T ECHNOLOGY

ness, etc., are in themselves part of the normal environment of the

organism. But when there is a weakness in the organism, then these
environmental influences in harmful amounts can penetrate the body,
giving rise to developments that lead to disease. This thinking is of
course not in any way alien to us, and does not account for the at-
traction of the Chinese models.
An essential difference from Western medicine lies in how the in-
dividual functional units, i.e., the individual primary organs, and the
secondary organs and functions ascribed to them are related to each
other, and in what way they influence each other and interact, for
example, with the harmful forces that have penetrated the body from
outside or have arisen in the body itself.
Acupuncture possesses the notion of different diseases present in
the body at the same time, which each gives rise to their own dis-
tinctive symptoms and which are to be treated separately. However,
this is rather the exception. As a rule, it is the task of the doctor
to determine an underlying disturbance in the body, from which the
therapy can be automatically based. Every diagnosis ideally leads to
a therapy. A diagnosis without a therapy is only possible when the
doctor reaches the conclusion that the condition is too advanced.
An further feature lies in the theoretical maxim that not only
are functions afflicted by harmful forces to be treated, but to observe
whether this was the area of function that was previously so weakened
as to allow the penetration of an evil. The spread of the evil in the
body follows definite laws, and theory obliges the healer to observe
the point of entry of the evil as well as the present stage and possible
complications of the illness.
In the course of the first millennium, these theories underwent
further elaboration culminating in Tang Dynasty in the seventh and
eighth centuries when authors unknown to us today devised highly
complex methods of calculation to tie the individual body, its condi-
tion, and its susceptibilities in with the course of the 60-year cycles
of cosmic activity. The corresponding texts are only just being trans-
lated and analyzed, and have so far not been a part of the current
reception of Chinese.
However, this indicates a feature of the reception of Chinese medicine.
The cause of the current high regard for Chinese medicine in the West
is not a well-founded knowledge of its history and theoretical fea-
tures, but rather vague feelings and the promise of something that is
allegedly different. When we look back over the history of medicine,
we see that not one system of ideas about healing, including our own,
stepped onto the stage in full bloom with convincing clinical success.
Each new system of ideas about healing first emerged as promise that
offers a certain plausibility, and which was strengthened or refuted by
the the elaboration that ensued in the following decades or centuries.
We did not embark on the road to our modern medicine 150 years
ago because we could see antibiotics, chemotherapy, and CT ahead
of us; those are things we could not even have dreamed. It was the
fundamental idea that the science could be applied to healing that
seemed to promising and convincing.
Even in the reception of Chinese medicine in the West, it is not so
decisive that the system is known in its entirely or that it is clinically
effective in every case. Much more important for modern acceptance,
the promise, with which Chinese medicine is propagated.
 P AUL U. UN S C H U L D 9

At the beginning of this speech, I spoke of the a new zeitgeist and

of existential fears that make segment of the population feel insecure.
The state of our civilization since the 1960s has been affected by a
number of factors. The problem of environmental protection increas-
ingly dominates public consciousness, and-whether rightly or wrong
is a question I shall leave open-chemistry takes the main blame for
change in the climate, in the ozone layer, in the quality of the water
as far as the Antarctic. The apocalyptical reports about increasing
chemical contamination of the environment encourage the fears of
which I spoke at the beginning.
The catch-word ‘technology’ is increasingly as negative loaded as
the word ‘chemistry.’ Despite the necessity of technology for our
present way of life and the benefits its brings, it gives rise to increasing
existential fears about its overpowering coldness, lack of feeling, and
inexorability.
The medicine that we practice and teach here in GroBhadern is
closely connected with these two factors, with chemical therapy and
medical technology. In a time when segment of the population is
developing increasing aversion to the role of technology and chem-
istry, it is not surprising that these aversions extend to the medical
application of chemistry and technology. The poisoning of the en-
vironment with dioxin pesticides, fluorocarbons, and other artificial
substances evokes negative associations with the poisoning of the in-
dividual body through chemotherapy. The increasing subjection of
human life to the cold dictates of technology evokes negative associ-
ations with the feelingless application of technology in the diagnosis
and treatment of individual sickness.
And this is where the ideology of Chinese medicine comes in. Chi-
nese medicine is justly presented by its advocates as a healing art
that gets by without technology and whose basis is direct encounter
between the patient and doctor. The needles that the acupuncturist
inserts cannot be so harmful; they are completely removed from the
body again.
Chemical effects with long-term consequences for the body do not
arise when the therapists uses Chinese drugs, for here the catch-words
‘natural healing’ and ‘natural drugs’ apply. Advocates argue that the
patient need not fear any pollution of the organism.
In addition, there is the catch-word ‘holism’. Many people com-
plain of the increasing splintering of the world into separate and in-
dependent entities. The loss of the center is a well-known image in
our modern civilization. The freedom of the indivudal has brought
loneliness to many people. In modern medicine, this development
is reflected in the well-known and oft lamented growing profusion
of highly specialized experts who are competent in their own small
patch, but not beyond it. Many patients see themselves and their
health problems confronted with a wall of experts amongst whom
they find no-one to talk heart to heart with.
It is this gap that traditional Chinese medicine promises to fill. A
therapist recognizes the common root of even the most diverse symp-
toms. While in Western medicine referrals are made to the specialist
in internal diseases, to the heart specialist, or the dermatologist, tra-
ditional Chinese medicine claims a central disturbance to be the cause
of apparently unrelated complaints which it promises to cure through
a single approach. This points the way to the center, the heart of
10 N ATURE V ERSUS C HEMISTRY AND T ECHNOLOGY

suffering, that a segment of the population seeks.

Our existential state has been influenced for several decades by
the energy problem. In the international arena, wars are fought to
secure our sources of energy; at home, the debate as to what energy
forms are the most practical, the cheapest, and the least harmful
to the environment constitutes a major point of conflict. For many,
the private energy balance is a constant reason for concern. Since
the whole history of medicine is characterized by models explaining
the threats to human organism that parallel those used to explain
threats to the social environment, it is not surprising that with the
expansion of the energy problem, a completely unscientific notion
gains plausibility in the population in the form of the notion that
energy flows within the body and disturbances of the energy economy
as the cause of individual sickness.
Western literature is dominated by the idea of acupuncture as a
energetic medicine. Such an idea has never existed in the history
of Chinese medicine. “Energy” in acupuncture literature is used to
denote the “pneuma” that both Western and Chinese antiquity un-
derstood to flow with the blood.
The habit of referring to the ancient Chinese concept of pneuma
with the modern Western concept of energy makes it clear that in
the reception of traditional Chinese medicine, the point would appear
not to be ensuring that Chinese medicine, as historically conceived,
arrives intact and undamaged like a Chinese vase or an old Chinese
sculpture.
Western conditions and desires play a more decisive role in the
transmission of Chinese medicine to the West than original notions
and ways of the thinking of the Chinese.
Modern scientific medicine medicine is not rejected by a segment
of the population because of any inefficacy; it is rejected because it is
closely connected with developments that cause concern for a segment
of the population.
Chinese medicine is not preferred by a segment of the population
because it is more effective than Western medicine (that is definitely
not the case), but because the ideas behind it respond to the needs
of the sector concerned and promise relief.
I have discussed the conditions that have lead to the spread of
Chinese medicine in the West. The fact that no small number of
patients have reported cures or improvements in their ailments in
the absence of systematic scientific proof, and have convinced other
patients, neighbors and family members to try acupuncture treatment
is just as much a secondary consequence of these conditions as the
understable economic interest of many doctors to gain competence in
this therapeutic approach.
To conclude, it is important to recognize that the problem of the
adoption of Chinese medicine will not be solved by encouraging sci-
entific confirmation of the individual concepts or therapeutic inter-
ventions of Chinese medicine. The increasing acceptance of Chinese
medicine is a question of people’s outlook on the world that will not
disappear until the existential anxieties and fears have dissolved, or
until the feeling arises that science and technology take these anxi-
eties and fears seriously.